Individual
DR. MARK WAYNE LANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
171851
AK
152W00000X
Optometrist
1934DT
KY
152W00000X
Optometrist
4901004481
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900A210610
BCBSM
MI
Enumeration date
04/18/2008
Last updated
04/01/2021
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